Fukuyama Congenital Muscular Dystrophy (FCMD) is an inherited condition that predominantly affects the muscles, brain, and eyes. FCMD is caused by a defect in the FKTN gene of both parents. FCMD affects the skeletal muscles, which are muscles the body uses for movement. The first signs of the disorder appear in early infancy and include a weak cry, poor feeding, and weak muscle tone (hypotonia). Weakness of the facial muscles often leads to a distinctive facial appearance including droopy eyelids (ptosis) and an open mouth. In childhood, muscle weakness and joint deformities (contractures) restrict movement and interfere with the development of motor skills such as sitting, standing, and walking. FCMD also impairs brain development. People with this condition have a brain abnormality called cobblestone Type II Lissencephaly, in which the surface of the brain develops a bumpy, irregular appearance (like that of cobblestones). These changes in the structure of the brain lead to significantly delayed development of speech and motor skills and moderate to severe intellectual disability. Social skills are less severely impaired. Other signs and symptoms of FCMD include impaired vision, eye abnormalities and slowly progressive heart problems after age 10.

DIAGNOSTIC

TESTING, PHYSICAL FINDINGS, AND ICD-9-CM CODING

Genetic testing of the amniotic fluid, if available in the records, may be helpful in diagnosing the disorder. Lab tests showing immunostaining of muscle, muscle biopsy, serum creatine kinase concentration and brain MRI.

ICD-9: 359.0 Congenital hereditary muscular dystrophy

ONSET AND PROGRESSION

Most children with Fukuyama congenital muscular dystrophy are never able to stand or walk, although some can sit without support and slide across the floor in a seated position. More than half of all affected children also experience seizures

TREATMENT

There is no definitive treatment for FCMD. There is treatment that is designed to improve quality of life. Such treatment can involve physical therapy with stretching exercises to promote mobility and prevent contractures, instruction in the use of mechanical assistive devices, weight control to avoid obesity, and instruction in the use of mechanical assistive devices to help ambulation and mobility. Management of gastroesophageal reflux and seizures, monitoring of respiratory problems and myocardial involvement is helpful.

SUGGESTEDPROGRAMMATIC ASSESSMENT*

Suggested MER for Evaluation:Clinical examination including a description of physical findings, family history, genetic testing with confirmed mutation in the FCMD gene, neurological examination, electromyography or nerve conduction tests and blood and enzyme tests.

Suggested Listings for Evaluation:

DETERMINATION

LISTING

REMARKS

Meets Listing

110.08 B

111.06 A & B

Fukuyama CMD produces long term interference with age appropriate activities resulting in extreme limitations of functioning.

Medical Equals

* Adjudicators may, at their discretion, use the Medical Evidence of Record or Listings suggested to evaluate the claim. However, the decision to allow or deny the claim rests with the adjudicator.